Choice, Access and Equity at AIDS 2024

July 26, 2024

Choice, access, and equity were central themes during the sessions and discussions at #AIDS2024 on Wednesday and Thursday. Highlights included new data on long-acting cabotegravir, a plenary calling out the need to move with speed, scale and equity in the rollout of new PrEP options, updated guidelines to improve access to post-exposure prophylaxis (PEP), a renewed commitment to the African Women’s Choice Manifesto, new data highlighting the omission of key populations from sustainability planning, and much more.

Click below to access AVAC’s daily reports from #AIDS2024 and read on for Wednesday and Thursday highlights.

Key Steps for Choice

The African Women’s Prevention Accountability Board (AWPCAB) continued to raise their voices and call on the international community to prioritize expanded access to existing products such as the dapivirine vaginal ring and injectable cabotegravir and developing new methods to ensure a range of prevention options for women and girls. Winnie Byanyima of UNAIDS pointed to her commitment to the Choice Manifesto, a declaration put forward by AWPCAB calling for sustained political and financial support for more choice in HIV prevention.  

At a Thursday satellite, HIV Prevention in the Time of Choice, Michelle Rudolph from WHO said they are “supporting PrEP options, also PrEP choice, prevention choice, and that includes the [dapivirine] ring, and we’ll continue to include the ring in all of our guidance moving forward.” Next steps for making choice a reality included curricula for training healthcare workers; more PrEP options for pregnant and lactating people; reducing costs through local manufacturing and technology transfers; and of course, community engagement.  

2 for the Price of 1: DPP as the next MPT 

In a workshop on the Dual Prevention Pill (DPP), Two for the price of one: Simplifying access to HIV prevention and contraception with multipurpose prevention technologies (MPTs), attendees brainstormed how to address real-world dilemmas that may come with rolling out the DPP, such as how to train HIV and family planning providers to deliver it; how will governments and donors balance the delivery of all proven methods for HIV prevention, including CAB for PrEP and the ring. Proposed solutions touched on the role of stakeholder engagement, models for demand creation and more. To learn more about the DPP and the full pipeline of MPTs, see AVAC’s Advocates’ Guide to MPTs. 

Pushing for Equity in Access: All PrEP & PEP

As the international community hailed the results of the PURPOSE 1 trial of injectable lenacapavir for PrEP in Wednesday’s Co-Chairs’ Choice session and called on its maker and international partners to plan for equitable access in its rollout (pending additional data and regulatory reviews), WHO published updated guidelines aimed at expanding access to post-exposure prophylaxis (PEP), a critical and under-used intervention in reducing new infections. These guidelines come on the heels of UNAIDS’ newest report showing an estimated 1.3 million new HIV infections in 2023, with increases seen in countries where  investment in prevention was lower. 

“We cannot say that we are doing well until we are doing well,” Jhpiego’s Elizabeth Irungu shared in Thursday’s plenary, HIV Prevention Strategies, speaking to the current state of PrEP choice, access and uptake globally. Irungu decried the historical delays in the rollout of oral PrEP and called on all stakeholders to break the 12-year cycle of squandering opportunities in prevention. 

The Inclusion of KPs in Country Planning for Sustainability: A report on pseudo engagement

The voices of key populations (KPs), such as gay men, other men who have sex with men, sex workers and people who inject drugs, are too often left out of sustainability planning, a process pushed by PEPFAR and UNAIDS. This was a finding from an analysis in six countries conducted by the Key Population Trans-National Collaboration (KP-TNC). From the session Integrating social enterprise for sustainability of key population programmes, AVAC’s Richard Muko, talked about some the causes behind this finding. These include cultural and religious beliefs that stigmatize KPs; reactionary policy moves that exclude KP voices; punitive laws targeting KPs; insufficient guidelines on how KP communities will be included in the sustainability framework; lack of political will and lack of understanding of KP needs in relation to HIV programming. “Some minimal communication can amount to pseudo involvement of KPs. But we see a signal that KP needs may be missing from the final sustainability roadmaps under development now.” The abstract on the study, Country HIV response sustainability roadmaps: where are key populations in the conversations?, calls for PEPFAR, Global Fund and UNAIDS to step up with frameworks for KP engagement in the development of sustainability roadmaps. 

Making the Case for an HIV Vaccine

Leaders in HIV prevention voiced unwavering support for vaccine development notwithstanding the scientific challenges, even as the world watches ARV-based interventions making enormous strides. In his plenary talk, Devin Sok of the Global Health Investment Corporation equated the HIV epidemic with a fire that can get out of control at any time. “We really need to reduce the embers to the point that we won’t have a fire… a vaccine will be essential for supporting epidemic control and eventually eliminating HIV as a public health threat.”  

Later in the day, the satellite session Ending the Epidemic: The role of a vaccine in the era of long-acting PrEP. Participants said the science in broadly neutralizing antibodies is accelerating with implications for vaccine research; investments in vaccine science have yielded unimaginable and enormous benefits (including COVID vaccines); and ultimately the choice of a vaccine remains essential to a sustainable and durable end to pandemic. As NIAID leader Jeanne Marrazzo said, “to understand any process that we can eventually apply to cure or to eliminate HIV, it’s got to involve an HIV vaccine.” And, ultimately, she said, there are populations of people who may never be as comfortable with ARV’s as a vaccine and vice versa.

AVAC’s AIDS 2024 Resources for Advocates

Stay tuned for more ways to unpack the new data, reports and discussion from AIDS 2024 including an upcoming webinar focused on what’s next in lenacapavir for PrEP advocacy.